The Changing Pattern of Healthcare in India

The evolution of healthcare in India over the past 25 years has been a mixed bag. While key health metrics such as the infant mortality rate (IMR) and maternal mortality ratio (MMR) have come down substantially, healthcare expenses have shot up—a direct fallout of lower public health spending. The government’s allocation to healthcare as a percentage of the country’s gross domestic product (GDP) has fallen to 1.05% in 2015-16 from 1.47% in 1986-87.

IMR has fallen to 41 per 1,000 live births in 2013 from 88 in 1990, according to a United Nations report ‘Levels and Trends in Child Mortality’ released in 2015. Similarly, according to a World Health Organization (WHO) report released in 2014, MMR in India has declined from 560 deaths per 100,000 live births in 1990 to 190 in 2013.

“Evidence from the ground supports this. We have made gains in maternal and child health by establishing public health systems in rural areas. The investments made through National Rural Health Mission (now under National Health Mission) have paid dividends in this area,” said Vandana Prasad, national convener, Public Health Resource Network and formerly with the National Commission for Protection of Child Rights.

But India has failed its citizenry when it comes to expenses on healthcare. Health surveys by the National Sample Survey Organisation (NSSO) show that since the 1990s, the dependence of Indians on private healthcare has risen sharply. In 1986-87, 60% of people availed of public health services and the rest private healthcare, according to the 42nd NSSO report. But by 2014, this trend was reversed, with only 41% availing of public healthcare, according to the 71st NSSO report released last year. The decline in dependence on public healthcare is sharper in urban areas—from 60% in 1986-87 to almost 32% in 2014.